Provider Demographics
NPI:1801807607
Name:BAILEY, THOMAS ANDREW (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N CANFIELD NILES RD STE 160
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2334
Mailing Address - Country:US
Mailing Address - Phone:330-953-3250
Mailing Address - Fax:330-918-1713
Practice Address - Street 1:25 N CANFIELD NILES RD STE 160
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2334
Practice Address - Country:US
Practice Address - Phone:330-953-3250
Practice Address - Fax:330-918-1713
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080265B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP006749OtherGATEWAY
OH000000160585OtherUNISON
OH000000329418OtherANTHEM
OH2313446Medicaid
OH770623234027OtherCARESOURCE
OHP00123854OtherRR MEDICARE
OH2313446Medicaid
OHP00123854OtherRR MEDICARE